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Chapter 16

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Western University
Psychology 1000
Derek Quinlan

CHAPTER 16: PSYCHOLOGICAL DISORDERS THE SCOPE & NATURE OF PSYCHOLOGICAL DISORDERS At any given point in time, 26% of the population suffers from a diagnosable mental disorder Nearly half of all North Americans between the ages of 15-54 will experience a psychological disorder at some point in their lives One adolescent commits suicide every 90 seconds What is Abnormal? Here are several possibilities: o The personal values of a given diagnostician o The expectations of the culture in which a person currently lives o The expectations of the persons culture of origin o General assumptions about human nature o Statistical deviation from the norm o Harmfulness, suffering, and impairment Until 1973, homosexuality was considered a form of mental illness (1) We are likely to label behaviours as abnormal if they are intensely distressing to the individual o Personal distress is neither necessary nor sufficient to define abnormality (2) Most behaviours judged abnormal are dysfunctional, either for the individual or for society o Behaviours that interfere with a persons ability to work or to experience satisfying relationships with other people are likely to be seen as maladaptive and self-defeating o Standards are not cut-and-dried (3) Criterion for abnormality is societys judgments concerning the deviance of a given behaviour o People are likely to be viewed as psychologically disturbed if they violate societys unstated norms, especially if the violations make others uncomfortable and cannot be attributed to environmental causes Abnormal Behaviour: behaviour that is personally distressing, personally dysfunctional, and/or so culturally deviant that other people judge it to be inappropriate or maladaptive HISTORICAL PERSPECTIVES ON DEVIANT BEHAVIOUR History is filled with accounts of prominent people who suffered from psychological disorders Throughout history, human societies have explained and responded to abnormal behaviour in different ways at different times, based on their values and assumptions about human life and behaviour Ex: witch hunts Hippocrates believed the site of mental illness was the brain By the 1800s, Western medicine had returned to viewing mental disorders as biologically based and was attempting to extend medical diagnoses to them Biological emphasis was given impetus by the discovery that general paresis, a disorder characterized by mental deterioration and bizarre behaviour, resulted from brain deterioration caused by syphilis o First demonstration that a psychological disorder was caused by an underlying physical malady In the early 1900s, Freuds theory of psychoanalysis ushered in psychological interpretations of disordered behaviours Importance of cultural factors began receiving attention Vulnerability-Stress Model: each of us has some degree of vulnerability for developing a psychological disorder, given sufficient stress o The vulnerability can have a biological basis, such as our genotype, over- or under-activity of a neurotransmitter system in the brain, a hair trigger autonomic nervous system, or a hormonal factor o Could also be due to a personality factor o Cultural factors could also contribute Vulnerability is only part of the equation In most instances, a predisposition creates a disorder only when a stressor combines with the vulnerability to trigger the disorder DIAGNOSING PSYCHOLOGICAL DISORDERS To be scientifically and practically useful, a classification system has to meet standards of reliability and validity Reliability: means that clinicians using the system should show high levels of agreement in their diagnostic decisions Validity: means that the diagnostic categories should accurately capture the essential features of the various disorders DSM-IV-TR is the most widely used diagnostic classification system in North America o Allows diagnostic information to be represented along 5 dimensions that take both the person and his or her life situation into account o Axis I: primary diagnosis; represents the persons primary clinical symptoms o Axis II: reflects long-standing personality or developmental disorders that could influence the persons behaviour and response to treatment o Axis III: notes any physical conditions that might be relevant o Axis IV: clinician rates the intensity of environmental stressors in the persons recent life o Axis V: persons coping resources are reflected in recent adaptive functioning DSM-V: Integrating Categorical & Dimensional Approaches Current classification system is a categorical system, in which people are placed within specific diagnostic categories o Criteria are so detailed and specific that up to 50% of people dont fit neatly into the categories o People who receive the same diagnosis may share only certain symptoms and look very different from one another o Also does not provide a way of capturing the severity of the persons disorder Alternative is the dimensional system, in which relevant behaviours are rated along a severity measure o Based on the assumption that psychological disorders are extensions different in degree, rather than in kind, from normal personality functioning o This system may better represent the uniqueness of each individual 6 basic dimensions of disordered personality functioning Negative emotionality, Schizotypy, Disinhibition, Introversion, Antagonism, Compulsivity o Rated by clinicians to define a set of 6 personality disorders Extraversion, Agreeableness, Conscientiousness, Neuroticism, Openness thought by proponents to be the universal dimensions of personality Critical Issues in Diagnostic Labeling Social & Personal Implications Once a diagnostic label is attached to a person, it becomes all too easy to accept the label as an accurate description of the individual rather than the behaviour Then becomes difficult to look at the persons behaviour objectively Diagnostic labels may also add to the burden of psychological disorders if the person with the disorder or others react negatively to the labels Because psychiatric labels often carry degrading and stigmatizing implications, the effects on morale and self-esteem can be devastating Expectation may become reality Legal Consequences The law tries to take into account the mental status of individuals accused of crimes Competency: refers to a defendants state of mind at the time of the judicial hearing o Defendant judged to be too disturbed to understand the nature of the legal proceedings may be labeled as not competent to stand trial and institutionalized until judged competent Insanity: relates to the presumed state of mind of the defendant at the time the crime was committed o Defendants may be declared not guilty by reason of insanity if they are judged to have been so severely impaired during the commission of a crime that they lacked the capacity to either appreciate the wrongfulness of their acts or to control their conduct It has become more difficult to plea insanity successfully Canada and an increasing number of US jurisdictions have adopted a verdict of guilty but mentally ill imposes a normal sentence for a crime, but sends the defendant to a mental hospital for treatment until they have recovered; once recovered, they are sent to prison for the remainder of the sentence Do I Have That Disorder? Medical Students Disease when people read descriptions of disorders, they often see some of those symptoms or characteristics in themselves ANXIETY DISORDERS Anxiety Disorders: the frequency and intensity of anxiety responses are out of proportion to the situations that trigger them, and the anxiety interferes with daily life Anxiety responses have 4 components: o (1) Subjective-Emotional Component includes feelings of tension and apprehension
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